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• <br />• <br />PERMIT APPLICATION <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />SITE ADDRESS: � PROPERTY TAX # f?ER�M^IT _� .� i� y� � <br />�( 21 � rr�a� ��, r� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER <br />jdress �2'ZZ S, 1 ZQ , 1 �• <br />PPLICANT: � Owner _ Owner's Agent _ Contractor <br />ONTRACTOR ��� �,hl ����{� <br />TENANT BUSINESS NAME <br />S� �,� �3,.� L I� D� a <br />BUILDING PERMIT APPLICATION <br />Phone/E-mail <br />ICity/State/Zip �q�� w�" � ���� <br />COf1lf8CtOf�S AgEflf _ T2f18f1� (must provide a lener of consent from the owner to do work in the space) <br />State Lic. # <br />�Phone/Email <br />CONTACT FOR PERMIT <br />Phone/E-mail 1 V 1.� � <br />CONTRACT PRICE OF WORK <br />Existing Use of Building ✓ <br />Proposed Use of Building Gas <br />Building type: _ Single Family _ Duplex _Townhouse _ Multi-Family � Commercial <br />Type of project: New Addition Remodel � Repair _ T.I. _ Sign _Sprinkler _De <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� ' <br />� <br />.. - ' <br />MECHANICAL PERMIT APPLICATION <br />pe of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />Water heater <br />Gas fireplace <br />� Gas range <br />I Clothes dryer <br />Range hood <br />� Exhaust fan <br />� Heat pump <br />j Unit heater <br />i Boiler <br />I Refrigeration <br />� Woodstove <br />Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />City Bus. Lic. # <br />Z� s G C-�i `3 R <br />HEAT SOURCE: <br />Electric Other <br />molition Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New �Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />� Toilet <br />� Bathtub <br />2 I Lavatory (wash basin) <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/e <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />I hereby certify that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local Iaw regulating construction <br />That I am authorized by ihe owner of this properfy to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />1���� I I� <br />OwnedAuthorized Aaent Sionature nate IRevi.serl.9/9�1.41 <br />